OmniSYS : Medicare Part B Services

medicare
part b
services

"Prescription volume has increased for Medicare patients since we began using your service."

"Our store and patients are getting paid for claims within two weeks."

"We certainly appreciate the service you provide - the customer service is excellent and the staff is very knowledgeable."

"OmniSYS' primary strength is its ability to customize its technology solutions for specific applications and clients."

"OmniSYS has become a valuable resource for Medicare with updates and changes to policies. "

"Medicare claim processing is much more efficient and the turn around payment time is outstanding."

"Medicare claim processing is much more efficient and the payment turn around time is outstanding."

Denial Tracking, Claims Correction/Resubmission:

Rest assured that we’re tracking every penny of every claim and effectively managing your receivables. Our Denial Tracking service further increases profits two-to-four percent, by timely and efficiently correcting and resubmitting rejections and denials. We also provide retrospective feedback using remittance received from Medicare to improve real-time edits and provide the most up-to-date data available.

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Electronic Remittance Posting:

With OmniSYS Electronic Remittance Posting, your pharmacy will have quicker access to payment information and be able to easily reconcile payments to the correct claims. Electronic ANSI 835 remittance provides details on how your claims were paid or why they were denied. Manual posting can be eliminated, while archived payment data can be easily retrieved, improving workflow and productivity.

The ANSI 835 can be automatically loaded onto your accounts receivable system, allowing instant transfer of time-sensitive remittance data, in a fully secure, HIPAA compliant environment. Our team will work with you and your payers to ensure the necessary EDI enrollment paperwork has been completed, saving you time and money.

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Eligibility Verification:

CareCLAIM from OmniSYS includes over 400 proprietary edits that ensure "clean claims" including checks for missing or invalid patient information. Excluding patient eligibility, the majority of claims that pass CareCLAIM’s edits are paid when first submitted to Medicare. One edit checks the format of the patient’s HICN (Cardholder ID) for proper length and mix of alphanumeric characters; however, this edit cannot identify when two digits are inadvertently reversed within an HICN. This is one example of "data entry" errors that result in Medicare denials.

Patient eligibility issues represent the primary reason for Medicare denials - over twenty percent (20%) of submitted claims are for ineligible patients or for patients with missing or invalid eligibility information. In fact, so-called "ineligible" patients usually are eligible but the patient information submitted is not sufficient to identify the patient through Medicare’s Common Working File.

Patient information needs to be correct before claims are submitted to Medicare. Ideally, your pharmacy management system should match the Common Working File. Other types of eligibility errors include patients enrolled in Medicare HMOs (as opposed to traditional Part B) and claims with dates-of-service that fall outside the patient’s Medicare Part B Effective/Termination dates.

Medicare claims processed through OmniSYS benefit from online eligibility edits that automatically check for eligibility on each Medicare claim you submit - at the same time other edits are performed. CareCLAIM from OmniSYS includes eligibility verification with customized NCPDP messaging that drives the pharmacy to match the Common Working File.

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EOB Posting:

Manually posting payments from paper Explanation of Benefits (EOB) forms may tie up valuable resources you could use elsewhere. OmniSYS can simplify this tedious process for you. Send us your paper EOBs, and we will standardize the payment information into an electronic file that can be applied to your accounts receivable system weekly. The system automatically links payments to correct prescription numbers for all claims submitted through OmniSYS. As a result, you experience fewer errors, save time and reduce DSO.

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Patient Invoicing:

OmniSYS Patient Invoicing utilizes remittance and real-time response information to identify patient cost share that may be outstanding for Medicare claims with no secondary insurance coverage. We will invoice patients on your behalf, provide customer support for their invoice questions and post payments received to the outstanding account. This service not only saves time for your pharmacy, it also reduces compliance risk.

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Reporting Packages:

At OmniSYS, we have a dedicated team of analysts who are responsible for monitoring claim data, identifying trends and providing recommendations for improvements. We provide standard and premium reporting packages that give you in-depth access to your data through online, interactive reports. Our premium Quarterly Value Report includes over 20 pages of in-depth analysis, data, trends and a comparison to the OmniSYS book of business.

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Support:

800.666.4797
24 hours a day
Sales:

800.448.6891
Local:

903.455.0461
Fax:

903.455.7910
E-mail:

mail@omnisys-llc.com
Call us today at 800.448.6891